There is a lot of out-of-date information about osteoarthritis, which can cause lots of osteoarthritis ‘myths’ to develop and circulate.

Let’s now review the most common osteoarthritis myths.

Myth 1: Pain comes from wearing down of the cartilage.

Fact: Your joints do not wear out with everyday use. People often think osteoarthritis pain is due to ‘wear and tear’ of the joint cartilage and ‘bone rubbing on bone’. But cartilage does not have nerves. This means that cartilage changes cannot cause pain. Osteoarthritis affects the whole joint including the ligaments and muscles. These tissues can contribute to joint pain. Your mood, emotions and sleep quality can also impact the amount of pain you feel in your joint.

Myth 2: Exercise and loading the joints with osteoarthritis will cause further damage.

Fact: The opposite is true. We now know that exercise and load through the body’s joints is vital for the health of our joint tissues. This includes the cartilage, bone and muscles. The old saying of ‘use it – or lose it’ holds true.  Joints need movement to keep them as healthy as possible. Avoiding exercise, like walking, to prevent the joints cartilage from ‘wearing out’ isn’t correct. In fact, regular exercise and physical activity can make many of the symptoms of osteoarthritis (such as pain) feel better!

Myth 3: Pain due to knee osteoarthritis will inevitably get worse over time.

Fact: The majority of people do not get worse. Most people remain stable. They may have bad times and good times but overall don’t continue to worsen. Some people find their symptoms even get better over time. Exercise is a great way to reduce pain and keep the knees healthy.

Myth 4: Experimental treatments will replace lost cartilage and improve joint pain.

Fact: Unfortunately, there are no quick fixes when it comes to osteoarthritis. Experimental treatments, such as stem cell injections are expensive and currently there is no good quality research showing that they work. Stem cells or platelet rich plasma injections into the joint are not currently recommended. Also, surgeries to ‘clean out the joint’ typically don’t improve joint symptoms and are not recommended for people with osteoarthritis anymore. Exercise and maintaining a healthy weight are the key recommended treatments. This is based on strong scientific evidence.

Myth 5: Joint replacement surgery is inevitable.

Fact: For most people, symptoms of osteoarthritis will generally be stable, with occasional flare-ups from time to time. While a flare will make you feel worse for a little while, the pain will usually settle down again in time. Most people’s osteoarthritis will not become severe enough to need a joint replacement. In fact, your pain may improve over time.

In the next section, we’ll discuss pain and what influences joint pain.

Here’s the scientific research that supports this information:

National Clinical Guideline Centre. Osteoarthritis. Osteoarthritis in over 16s: diagnosis and management. Clinical guideline NG226. Methods, evidence and recommendations. London; National Institute for Health and Care Excellence, 2022.

Kraus V et al., Effects of physical activity in knee and hip osteoarthritis: a systematic umbrella review, Medicine & Science in Sports & Exercise, 2019; 51(6).

Fransen M et al., Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews, 2015.

Hunter DJ et al., Osteoarthritis. The Lancet 2019; 393: 1745.

Pain is the most common symptom of knee osteoarthritis.

Learning more about the factors that can influence your knee pain can help you better manage it.

Pain is complex. Pain is not a simple matter of ‘damage leads to pain’. Increased joint pain generally does not mean that you have damaged your joint. It used to be thought that pain was just a simple message from your osteoarthritic joint straight to the brain. However, lots of research has shown that pain is much more complex than that, and that the brain can change how you interpret messages of pain. There are a range of different factors that influence why and how you feel pain, including;

the sensations from your knee joint and surrounding muscle and tissues

 your mood, anxiety and stress levels

 your fatigue levels and/or quality of sleep

 your thoughts, worries and fears about pain

 sometimes just focussing too much on the pain can make it seem worse.

It’s the brain and nervous system’s job to make sense of all these factors and decide if you feel pain and how much. Think of the brain like a volume dial. The brain interprets all the factors that influence your pain. The brain then decides to turn the pain level up or down. For example, when you feel stress or anxiety the pain volume can turn up. When you do something fun that distracts you, the pain volume can turn down.

If you’ve had pain for a long time your pain system becomes overly protective. This means things that didn’t previously hurt now do. It makes sense. If you’re in pain, you want to avoid activity. But being less active can make your pain worse over time. Inactivity causes muscle weakness and loss of cardiovascular fitness. You can gain weight. Your mood and sleep problems can get worse. All these things can make your pain worse and make you avoid activity even more.

Excitingly, pain scientists have discovered that everyone can ‘retrain’ their pain system. If you change how you think about and respond to pain, you can take more control of your pain. You can start retraining your pain system by slowly increasing how much you move and how active you are.

Watch the video below to learn more. In the video, Australian Pain Scientist Professor Moseley describes new discoveries about persistent pain. He also talks about the importance of exercise and movement in pain management.

In the next section, we’ll discuss knee pain and knee osteoarthritis treatments.

Here’s the scientific research that supports this information:

Butler DS, et al., . Explain Pain: Noigroup Publications, 2013.

Knee osteoarthritis can be managed successfully.

The most beneficial treatments for ALL people with knee osteoarthritis are exercise and physical activity. In addition to these treatments pain-relieving medication may be suitable for some people. In some cases, where symptoms are severe and other treatments are not helping, joint surgery may be a suitable option.

Exercise. Regular exercise has many benefits for people with knee osteoarthritis. It helps reduce symptoms (e.g. pain, stiffness). It improves knee mobility and muscle strength. It improves sleep quality and mood.

Some other ways to manage knee pain include:

Education. Learn about knee osteoarthritis. Read all the information provided in MyJoint Tai Chi to better understand knee pain and exercise. You might like to visit other websites for more information. See the list at the bottom of this page.

Weight management.  Controlling weight (if needed) is important for general health. Although, currently there isn’t enough research to know if weight loss reduces knee pain. If you’d like to explore weight loss, speak with your doctor for advice on safe and effective weight loss strategies.

Assistive walking devices. Canes (e.g., walking sticks), crutches and walkers can help you stand more upright, reduce pressure on your joint, improve balance and may help with pain. They are also helpful to reduce falls risk. They can be purchased or rented from physiotherapy clinics, pharmacies, or online retailers.

Medication. Pain-relieving medication can help during times of more severe pain. Speak with your doctor to find out what medication might work for you.

Relaxation & pain coping techniques. Techniques to try include meditation, progressive muscle relaxation and pleasant imagery. They can help manage pain. They can also help with emotions. Worry, fear, anxiety, even anger are all common things to feel when you’ve had pain for a long time.

Surgery.  If you have tried other treatments including exercise and weight management (if appropriate) OR if your knee osteoarthritis is advanced OR if symptoms can no longer be tolerated, surgery might be an option. The knee joint can be replaced with an artificial joint.

Watch the video to learn more about recommended osteoarthritis treatments.

In the next section, we’ll discuss more about exercise as a treatment for knee osteoarthritis.

Here’s the scientific research that supports this information:

The Royal Australian College of General Practitioners, Guideline for the management of knee and hip osteoarthritis. 2nd edition ed, Victoria, Australia, 2018.

Bannuru RR et al., OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage, 2019. 27(11): p. 1578-1589.

National Clinical Guideline Centre. Osteoarthritis. Osteoarthritis in over 16s: diagnosis and management. Clinical guideline NG226. Methods, evidence and recommendations. London; National Institute for Health and Care Excellence, 2022.

Exercise is an important treatment for knee osteoarthritis.

A lot of people with painful knees think they shouldn’t exercise. But, exercise is a vital part of managing knee pain, even very painful knees

Regular exercise:

keeps joints healthy and moving

maintains fitness

improves mood

maintains weight

reduces the risk of other health conditions that can make managing knee pain harder (obesity, heart conditions, diabetes)

can lower feelings of social isolation if done with other people

Also, regular exercise can prevent or reduce the need for pain relieving medication. In fact, scientific research has shown the benefits of exercise on pain are similar to the effects achieved with pain relieving medications like paracetamol and non steroidal anti inflammatory drugs (NSAIDs) – but exercise doesn’t have the risks or side effects of medications!

Scientific evidence has also shown exercise can help people with osteoarthritis avoid or delay the need for joint replacement surgery. 

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Exercise options that might be suitable for you. 

A range of different types of exercises can help symptoms for people with knee osteoarthritis. These include mind-body exercise (e.g. Tai Chi or yoga), strength exercise, aerobic exercises (e.g. walking) and general physical activity. You can choose the type(s) of exercises that are suitable for you. 

Mind body exercise:
Mind body exercises, such as Tai Chi and yoga, combine strength, flexibility and balance training.  They have been proven to improve pain, physical function and mental well-being for people with knee osteoarthritis. Incorporating mind-body exercises into your routine can provide a holistic approach to managing knee osteoarthritis symptoms and improving your overall health.

Strength exercise:
All people with knee osteoarthritis should do some type of leg strengthening exercise. Regular strength exercise makes the muscles around your knee strong and supportive. Over time strength exercise can reduce pain and help you be more active. It’s recommended to do 3 sessions each week to see benefits.

Aerobic exercise: 
Aerobic exercises, such as walking, swimming and seated stepper, promote the release of natural pain-relieving chemicals in the body. It can make you feel good and contribute to overall well-being. Try to engage in 20-30 minutes of low to moderate level of aerobic exercises each day. 

 General physical activity:
For knee and general health, people should spend some time on most days being physically active. It’s recommended everyone do at least 150-300 minutes of moderate intensity (e.g. brisk walking, doubles tennis) aerobic physical activity per week. Moderate activity means you feel like you’re putting in some effort and not just cruising along being gentle. But, if moderate activity is too difficult or causes discomfort, light activity is still beneficial. You also don’t need to do 20-60 minutes of activity all at once. Bouts of activity 10 minutes at a time works too!

Watch the video to learn more about exercising with osteoarthritis.

.In the next section, we’ll discuss common concerns people with knee osteoarthritis have about exercising.

Here’s the scientific research that supports this information:

Kraus V et al., Effects of physical activity in knee and hip osteoarthritis: a systematic umbrella review, Medicine & Science in Sports & Exercise, 2019; 51(6).

Fransen M et al., Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews, 2015.

World Health Organization, WHO guidelines on physical activity and sedentary behaviour. Geneva: World Health Organization; 2020.

Bannuru RR et al., OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage, 2019. 27(11): p. 1578-1589. 

Although exercise is an important part of managing osteoarthritis, many people with knee pain feel nervous about starting regular exercise. Let’s discuss three common concerns people with knee osteoarthritis have about exercise.

Concern 1: “Exercise will further damage my joint”

Response: The opposite is true- research shows that “loading” joints, for example when you exercise, is important for the health of a joint’s cartilage. Think of exercise as a joint lubricant. Many people avoid using their painful joint for fear of making it worse. But, when you don’t move your joints, they become stiffer. The muscles around the joint become weaker and less supportive. Over time, this can lead to even more pain and stiffness. The old saying of ‘use it – or lose it’ holds true. Our joints need movement and exercise to keep them as healthy as possible.

Concern 2: “Last time I exercised my joint pain got worse”

Response: It’s common to feel pain in your muscles or joint during or straight after exercise. Even people who don’t have osteoarthritis feel this too. Research suggests that pain flares (an increase in joint pain) are acceptable and safe, as long as pain returns to baseline levels within about 24 hours after exercise. Remember that pain isn’t an accurate measure of what is happening inside the joint. But, if you do find that pain is limiting your ability to stick to exercise, or your pain is aggravated for more than 24 hours after exercise, it might be time to seek professional help. For example, a physiotherapist is a trained exercise expert. They can tailor a program to your needs and abilities.

Concern 3: “Exercise is a waste of time. I’ve exercised before, it didn’t make a difference”

Response: Don’t be worried if exercise doesn’t result in immediate pain relief. It takes time and commitment to see benefits. It can take up to 12 weeks to see real changes in your symptoms. For example, research shows that it can take 4-12 weeks to start to see changes in your muscle strength after doing consistent strength training. It’s also important to keep challenging yourself and progress your exercise routine when it becomes too easy. This way you keep improving. You might also find some types of exercise work better for you than others. So, another thing to consider is trying a different type of exercise. You’ll find a range of ideas in the next section ‘What physical activity and exercise is suitable for people with osteoarthritis?’. If you’re still having trouble seeing benefits from exercise, it might be time to seek professional help. A physiotherapist can help you progress your exercises, so you keep seeing benefits over time.

Watch the video to learn more about the safety of exercise for people with osteoarthritis.

Here’s the scientific research that supports this information:

Kraus V et al., Effects of physical activity in knee and hip osteoarthritis: a systematic umbrella review, Medicine & Science in Sports & Exercise, 2019; 51(6).

Fransen M et al., Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews, 2015.

Hunter DJ et al,.. Osteoarthritis. The Lancet 2019; 393: 1745.